A prospective study of comparison between transvaginal sonogram and histopathological examination in perimenopausal women with abnormal uterine bleeding

P. Rishma Priyanka, C. Rama Mani, A. Yamuna
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(11) , pp. 4233 · doi:10.18203/2320-1770.ijrcog20194609 · W2980688629
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This prospective study in perimenopausal women with abnormal uterine bleeding found that transvaginal sonography correlates well with histopathology and outperforms dilatation and curettage in detecting adenomyosis and polyps.

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This prospective study compared transvaginal sonography and dilation and curettage against histopathological examination in 100 perimenopausal women presenting with abnormal uterine bleeding. The results indicated that an endometrial thickness of 15 mm or greater correlated with hyperplasia or carcinoma, while thinner measurements generally aligned with normal endometrium. Although transvaginal sonography proved to be a useful non-invasive screening tool, the researchers noted that dilation and curettage missed several cases of adenomyosis, endometrial polyps, and myomatous polyps. Relevance to endometriosis: Adenomyosis is listed as one condition detected by imaging but missed by curettage, though the paper's primary focus remains on evaluating diagnostic methods for perimenopausal bleeding rather than specifically studying endometriosis or adenomyosis pathology.

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Abstract

Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.
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Background

Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.

Methods

A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.

Results

With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.

Conclusions

TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage. Metrics

References

Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia a long-term study of untreated hyperplasia in 170 patients. Cancer. 1985;56:403-12. Mc Ellin TW, Burd CC, Reeves BD. Diagnostic dilatation and curettage. J Obstet Gynecol. 1969;33:807. Pillai S. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3:113-7 Lewin A, Gabis L, Ushakov F, Anteby SA, Endometrial measurement by transvaginal sonography in post-menopausal bleeding, Harefuah. 1996;130(10):662-8. Malinova, Pehlivano V. Trans vaginal sonography and endometrial thickness in patients with postmenopausal uterine bleeding. Eu J Obstet Gynaecol Repro Biol. 1995;58(2):161-5. Loverro G, Bettocchi S, Cormio G, Nicoloardiv. Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding. Marturitas. 1999;33(2):139-44. Get Pook C, Wattanakumtornkill S. Endometrial thickness screening in premenopausal women with abnormal uterine bleeding. J obstet Gynaecol Res. 2006;32(6):588-92. Guisa-Chiferi MG, Gonfolalva WJ, Baract EC, Transvaginal ultrasound, uterine biopsy and hysteroscopy for postmenopausal bleeding. Int J Gynaecol Obstet. 1996;55(1):39-44. Choudhary J, Acharya V, Jain M. Evaluation of abnormal uterine bleeding with transvaginal sonography and hysteroscopy in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2017;6:3607-13.

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